Tuberculosis case burden and treatment outcomes in children, adults and older adults, Vanuatu, 2007-2011

Setting: All five DOTS centres in Vanuatu. Objectives: To determine across the age spectrum the tuberculosis (TB) case burden, disease pattern and treatment outcomes in patients registered between 2007 and 2011. Design: Retrospective cohort study involving reviews of TB registers and treatment cards. Results: Of 588 TB patients, 142 (24%) were children (aged 0-14 years), 327 (56%) adults (aged 15-54 years) and 119 (20%) were older adults (aged >= 55 years; subdivided into 55-64 and >= 65 years); 568 were new patients, 13 had been treated previously and 7 had unknown status. Compared with adults, children with new TB had a higher prevalence of extra-pulmonary TB (75% vs. 34%, OR 5.7, 95% CI 3.6-9.0) and a lower prevalence of smear-positive pulmonary TB (11% vs. 45%, OR 0.15, 95% CI 0.1-0.3), while older adults with new TB had a higher prevalence of smear-negative pulmonary TB (38% vs. 21%, OR 2.4, 95% CI 1.5-3.8). Overall TB treatment success was 83%, but in the second category of older adults (>= 65 years) treatment success was 67% and case fatality was 18%. Conclusion: Children and older adults constitute 45% of the TB burden in Vanuatu. Differences in disease patterns and poorer treatment outcomes in older adults have implications for policy and practice.